An 82-year-old woman, who suffered from worsening dementia, was
admitted to the dementia unit at a private hospital for respite
care, and remained there for nine days. During the woman's brief
admission she sustained a number of injuries.

The woman's admission assessment, undertaken on the day
following admission, contained contradictory information. An
initial care plan was also developed the day following admission,
and it did not contain certain details about the woman's behaviour
and preferences. In addition, there was confusion about her
medications.

One night, a healthcare assistant (HCA) on duty in the dementia
unit physically abused the woman. The HCA grabbed the woman's upper
arms, causing bruising, and slapped the woman's upper thigh,
causing bruising. Another HCA observed and overheard the physical
abuse of the woman. That HCA did not report the incident overnight,
and did not complete an incident form. The following morning, a
further HCA reported to a registered nurse (RN) that there was some
bruising on the woman's body. While it was noted that the woman had
fingermark bruises on her upper arms, the incident report completed
did not refer to other details such as the woman's complaints that
the bruising was caused by a staff member, or that she had been
"bashed on the knee".

After breakfast, the woman was not able to walk, which was not
normal for her as usually she mobilised freely. An RN examined the
woman's left leg and found it was swollen and shiny, so contacted
the woman's GP and advised him of the swelling and enquired about
an X-ray. The GP was not informed of the woman's other
injuries.

The woman was taken by her family to a public hospital, and was
discharged the next day into the care of her family. The woman died
around three months later.

The private hospital commenced an internal investigation into
the circumstances relating to the woman's injuries, and the HCA was
suspended. Following the investigation, the HCA was dismissed for
serious misconduct. The matter was referred to the Police.

It was held that the HCA failed to provide services to the woman
that complied with professional and ethical standards and,
accordingly, she breached Right 4(2).

The initial care plan and incident reports did not contain
adequate information, and the initial care plan was not updated to
take into account changes in the woman's condition. The medication
management was suboptimal, and staff failed to assess the woman's
injuries adequately and manage them appropriately. The private
hospital is responsible for the multiple shortcomings in the care
its staff provided to the woman and, accordingly, breached Right
4(1).

Adverse comment is made that the HCA did not receive additional
training on abuse and neglect following an earlier incident where
there was an allegation of the HCA physically abusing another
resident. Adverse comment is also made about the second HCA's
failure to report the incident at the time that the woman was
abused.

The HCA was referred to the Director of Proceedings. The
Director decided not to issue proceedings.